Combining alcoholics anonymous and treatment works best

Most clinical studies examine individuals either during or immediately following treatment. A study in the October issue of Alcoholism: Clinical & Experimental Research tracks individuals for 16 years who have first acknowledged their alcohol-use problems and then chosen Alcoholics Anonymous (AA), treatment, or both.

Findings indicate that people who become involved in both AA and treatment fare better than those who obtain only treatment.

"We know that self-help groups, such as AA, contribute to better alcohol-related and psychosocial outcomes," said Rudolf H. Moos, senior research career scientist for the Department of Veterans Affairs Health Care System in Palo Alto, California, and corresponding author for the study. "For example, patients with alcohol use-disorders who participate in AA, and those who attend more meetings and/or participate for a longer time, are more likely to be abstinent and to maintain remission up to five years after an episode of professional treatment than patients who are not involved or less involved in such groups. Affiliation with AA also is associated with more self-efficacy and problem-solving coping skills, and better social functioning, which are linked to better alcohol-related outcomes."

Moos and his colleague(s) wanted to further examine the even longer-term outcomes of AA and treatment, and how they might interact with one another. "In the current study, we wanted to find out whether individuals who participated only in AA in the first year after initiating help-seeking (and did not obtain professional treatment) achieved outcomes comparable to those of individuals who participated in AA and also obtained professional treatment. We also wanted to find out whether individuals who participated in AA in the first year achieved better long-term outcomes."

Researchers surveyed 362 individuals (193 females, 169 males) who had initial contact with an alcoholism treatment system for their alcohol-use disorder. Study participants were asked about their subsequent participation in AA and/or treatment, as well as their alcohol-related functioning, at baseline (initial contact) and then again at one, three, eight and 16 years later.

"One, individuals who enter AA relatively quickly after initiating help-seeking, either alone or in conjunction with treatment, are more likely to participate in AA in the subsequent 15 years and participate in AA more frequently and for a longer duration," said Moos. "Two, a longer duration of participation in AA is associated with a higher likelihood of continuing remission up to 15 years later. Three, individuals who obtain professional treatment and participate in AA in the first year after initiating help-seeking are more likely to achieve remission for up to 15 years later than are individuals who obtain professional treatment alone. Finally, individuals who have achieved remission but who discontinue participation in AA are at increased risk for relapse; individuals who have not stopped drinking and who discontinue participation in AA are more likely to continue drinking."

"These findings are consistent with previous studies of AA," said William R. Miller, Distinguished Professor of psychology and psychiatry at the University of New Mexico. "As we already knew, drop-out from AA is high. Nevertheless, involvement in AA during, and in the few years after, treatment is associated with better long-term outcomes. An additional 10 to 20 percent were in remission, which is a large and clinically meaningful difference. Of those who do not attend AA during treatment, many don't [ever] go, and if they do, [their] delayed entry to AA is associated with less benefit. In sum, there are good reasons to encourage people to get involved with AA while they are still in treatment."

"These findings emphasize that initial and subsequent episodes of participation in AA can have long-term effects on the likelihood of remission of alcohol-related problems," said Moos. "They also emphasize that counselors in information and referral centers and clinicians in substance use treatment settings should make every reasonable effort to enable individuals with alcohol-related problems to enter and continue to participate in self-help groups such as AA."

"Are these better outcomes due specifically to AA?" asked Miller. "We can't be sure. In general, the more actions people take toward their own recovery the better they do, whether it is attending treatment, going to AA, or faithfully taking medication. It is an impressively consistent finding, however, that people who go to AA during treatment have better outcomes. I do not believe that anyone should be required to attend AA, but certainly treatment providers and programs should be seriously encouraging patients to give it a try. Both treatment and AA seem to add something, and the people with the best outcomes are those who get involved in both. In short, AA is not a replacement for treatment, and treatment is not a substitute for AA."

Moos and his colleagues will continue to investigate the benefits of AA. "One of our future projects will try to identify individuals who can achieve abstinence or remission after professional treatment without participation in AA," he said. "Even though participation in AA has substantial benefits, these benefits do not necessarily accrue to all types of individuals; it is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcohol-related problems."